Yang Ming, Li Guangjun, Chen Kunlin, Wu Youwei, Sun Ting, Wang Wentao
Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Int J Surg. 2025 May 1;111(5):3456-3466. doi: 10.1097/JS9.0000000000002302.
Controversy remains regarding liver resection (LR) and radiofrequency ablation (RFA) for patients with single hepatocellular carcinomas (HCCs) measuring 3 cm or less. The purpose of our study was to compare the prognosis between LR and RFA in patients with solitary HCCs ≤3 cm.
The meta-analysis followed the PRISMA guidelines and the Cochrane Handbook. All RCTs and cohort studies that compared LR versus RFA in patients with solitary HCCs ≤3 cm were comprehensively searched in the PubMed, Cochrane Library, Embase, and Web of Science databases up to 30 January 2024. The primary endpoints were overall survival (OS), recurrence-free survival (RFS), and disease-free survival (DFS).
A total of 6356 patients with solitary HCCs ≤3 cm and 5829 patients with solitary HCCs ≤2 cm from 39 included studies were analyzed (LR = 5759, RFA = 6426). The present meta-analysis of two RCTs showed no statistically significant difference in OS between LR and RFA. However, the meta-analysis of cohort studies revealed that, compared with RFA, LR conferred a superior OS advantage (hazard ratio [HR] = 0.80, 95% confidence interval [CI]: 0.68-0.93, P = 0.005). There was a significant improvement in the DFS rate with LR over RFA (HR = 0.63, 95% CI: 0.49-0.81) and in the RFS rate (HR = 0.65, 95% CI: 0.55-0.76). Compared with RFA, LR resulted in better OS (HR = 0.73, 95% CI: 0.54-0.97), DFS (HR = 0.74, 95% CI: 0.67-0.82), and RFS (HR = 0.71, 95% CI: 0.57-0.90) in patients with a solitary HCC lesion ≤2 cm.
Evidence from cohort studies suggested that in patients with a solitary HCC lesion ≤3 cm, LR is preferable to RFA. Additional RCTs are needed to confirm the validity of this evidence.
对于直径3厘米及以下的单发肝细胞癌（HCC）患者，肝切除术（LR）和射频消融术（RFA）仍存在争议。我们研究的目的是比较LR和RFA对直径≤3厘米的单发HCC患者的预后情况。
本荟萃分析遵循PRISMA指南和Cochrane手册。截至2024年1月30日，在PubMed、Cochrane图书馆、Embase和科学网数据库中全面检索了所有比较LR与RFA治疗直径≤3厘米的单发HCC患者的随机对照试验（RCT）和队列研究。主要终点为总生存期（OS）、无复发生存期（RFS）和无病生存期（DFS）。
对39项纳入研究中的6356例直径≤3厘米的单发HCC患者和5829例直径≤2厘米的单发HCC患者进行了分析（LR = 5759例，RFA = 6426例）。两项RCT的当前荟萃分析显示，LR和RFA在OS方面无统计学显著差异。然而，队列研究的荟萃分析显示，与RFA相比，LR具有更好的OS优势（风险比[HR]=0.80，95%置信区间[CI]：0.68 - 0.93，P = 0.005）。LR的DFS率（HR = 0.63，95% CI：0.49 - 0.81）和RFS率（HR = 0.65，95% CI：0.55 - 0.76）有显著改善。与RFA相比，对于直径≤2厘米的单发HCC病变患者，LR的OS（HR = 0.73，95% CI：0.54 - 0.97）、DFS（HR = 0.74，95% CI：0.67 - 0.82）和RFS（HR = 0.71，95% CI：0.57 - 0.90）更好。
队列研究的证据表明，对于直径≤3厘米的单发HCC病变患者，LR优于RFA。需要更多的RCT来证实这一证据的有效性。
